Lung cancer ranks first in incidence and mortality in China. Surgery is the primary method to cure cancer, but only 20–30% of patients are eligible for curative resection. In recent years, in addition to surgery, other local therapies have been developed for patients with numerous localized primary and metastatic pulmonary tumors, including stereotactic body radiation therapy and thermal ablative therapies through percutaneously inserted applicators. Percutaneous thermal ablation of pulmonary tumors is minimally invasive, conformal, repeatable, feasible, cheap, has a shorter recovery time, and offers reduced morbidity and mortality. Radiofrequency ablation (RFA), the most commonly used thermal ablation technique, has a reported 80–90% rate of complete ablation, with the best results obtained in tumors < 3 cm in diameter. Because the clinical efficacy of RFA of pulmonary tumors has not yet been determined, this clinical guideline describes the techniques used in the treatment of localized primary and metastatic pulmonary tumors in nonsurgical candidates, including mechanism of action, devices, indications, techniques, potential complications, clinical outcomes, post‐ablation surveillance, and use in combination with other therapies. In the future, the role of RFA in the treatment of localized pulmonary tumors should ultimately be determined by evidence from prospective randomized controlled trials comparing sublobar resection or stereotactic body radiation therapy.

Although surgical resection is the primary means of curing both primary and metastatic lung cancers, about 80% of lung cancers cannot be removed by surgery. As most patients with unresectable lung cancer receive only limited benefits from traditional radiotherapy and chemotherapy, many new local treatment methods have emerged, including local ablation therapy. The Minimally Invasive and Comprehensive Treatment of Lung Cancer Branch, Professional Committee of Minimally Invasive Treatment of Cancer of the Chinese Anti-Cancer Association has organized multidisciplinary experts to develop guidelines for this treatment modality. These guidelines aim at standardizing thermal ablation procedures and criteria for selecting treatment candidates and assessing outcomes; and for preventing and managing post-ablation complications.

1 前言 在世界范围内肺癌居癌症发病率和死因之首,全球每年发病约250万人,每年有超过160万人死于肺癌[1].在我国肺癌的发病形势更加严峻,2010年新发肺癌 605,900人,死亡486,600人[2].估计2015年我国将新发肺癌733,300人,死亡610,200人[3],绝对数均排在世界第一.对于早期非小细胞肺癌(non-small cell lung cancer, NSCLC),外科切除是治愈的主要手段[4],但是由于各种原因,大约80%的肺癌无法通过手术切除治疗.对于无法手术切除的多数肺癌患者在传统的放化疗中获益有限,因此许多新的局部治疗方法应运而生,包括局部消融治疗等.

Objective To study the application value and safety of percutaneous coaxial-core needle biopsy via director assis-ted CT guidance in retroperitoneal lymphomas. Methods From June 2013 to May 2015, a total of 18 patients with retroperitoneal mas-ses couldn't undertaking surgercal biopsy were enrolled in this study. The 18 patients received percutaneous coaxial-core needle biopsy via director assisted CT guidance. At least five biopsy samples from different position were taken for pathology and immunohistochemis-try examination. A dosage of 10-30 mg of cisplatin was injected into the lesion by trocar needle. Results Of the 18 patients underwent percutaneous coaxial-core needle biopsy via director assisted CT guidance. The success rate of puncture and biopsy was 100%. Opera-tion time was 20-40 min (average 30 minutes), and 5-9 sequence with 45-90 pictures of scan were used. No complications such as hemorrhage and pneumothorax occurred. Ten cases of retroperitoneal lymphomas were diagnosed, among whom there were 6 cases of diffuse large B lymphoma, 2 cases of follicular lymphoma and 2 cases of lymphoid cell lymphoma. According to Ann Arbor stage,there were 2 of stage Ⅱ, 6 of stage Ⅲ, and 2 of stage Ⅳ. The combination of chemotherapy and radiation was performed on lymphoma pa-tients. Conclusion Percutaneous coaxial core needle biopsy via director assisted CT guidance with minimal invasiveness and fewer complications is a safe and effective minimally invasive technology, worthy of clinical application in the diagnosis of retroperitoneal lym-phoproliferative disease.

BACKGROUND:Radiofrequency ablation (RFA) has become one of the local treatment for inoperable early stage non-small cell lung cancer (NSCLC). This study observes effectiveness and safety of computed tomography (CT) guided RFA followed intratumoral chemotherapy (RFA-ITC).METHODS:From 2005 to 2015, our group perspectively enrolled inoperable early stage NSCLC underwent RFA-ITC duo to poor cardiopulmonary function or with other diseases or patient can't tolerate or reject surgery. RFA was performed by a directive apparatus assisted CT guided semi real-time and step-by-step puncture method, conformal umbrella-shaped electrode and single or multiple targets ablation. While the plan finished and CT showed normal lung tissue around the tumor present ground-glass opacity (GGO), the procedure ended, then 200 mg of carboplatinum were injected into the tumor via the electrode needle. Safety and effectiveness were evaluated by follow-up.RESULTS:Technical success rates of 125 RFA-ITC treatments of 110 patients were 100%. The median survival was 48.0 months, overall survival (OS) was 55.4 months, progression-free survival was 55.1 months, 1, 2, 3, 5-year OS rates were 100%, 90.7%, 62.7%, 21.9%, respectively. Survival of GGO presence or not was 68.3 months and 40.1 months, respectively (P=0.001). The survival rates of the N1 staging and tumor size was no significant difference. No perioperative deaths occurred, the main complications i.e. pneumothorax, pulmonary hemorrhage, pleural effusion, fever, intraoperative chest pain, subcutaneous emphysema, intraoperative cough were slight and tolerable.CONCLUSIONS:CT guided RFA-ITC provides a good method for treatment of inoperable early stage NSCLC with better survival, less complication and small damage.
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癌症,例如肺癌、肝癌是威胁人类健康的主要疾病,一旦发现患有癌症千万不能耽误,应立即积极诊断与治疗.那么,诊断与治疗恶性肿瘤的关键是什么呢?现代的癌症治疗的最新理念就是精准与绿色.

癌症,是威胁人类健康的主要疾病,一旦发现患有癌症千万不能耽误,应立即采取诊断与治疗.那么,诊断与治疗的关键是什么呢?现代的癌症治疗最新理念就是"精准"与"绿色".

患者女,59岁,因"肺癌1年余,发现左肘后包块2个月"于2011年11月24日入院.患者入院前1年因痰中带血,于中国医学科学院肿瘤医院诊断为左肺癌可能,8个月前于我院行左肺穿刺提示左肺腺癌,曾行肿瘤射频消融术及伽马刀治疗,病情平稳.入院前2个月患者发现左肘后包块,质软,约栗子大小,无触痛,未予重视.近1个月左肘后包块进行性增大,疼痛明显,局部活动受限,1d前出现咳嗽、咳黄痰,伴发热,体温最高39 ℃,为进一步诊治入院.既往有干燥综合征病史约20年,规律服用甲泼尼龙治疗(32 mg,3次/d),另有Evens综合征病史10年,高血压、冠心病病史多年.查体:生命体征平稳,满月脸,体形肥胖,ZPS评分3分,双肺呼吸音粗,右上肺可闻及湿性啰音,肝脏剑突下5 cm可触及,质硬,无压痛.左侧肘后部可见一拳头大小包块,局部皮温升高,伴明显压痛,远端组织水肿,双下肢凹陷型水肿.

<正>替莫唑胺(TMZ)是一种新型的烷化剂,于1999年获美国FDA批准上市。随后,欧洲癌症治疗研究组织与加拿大国际癌症研究院(EORTC-NCIC)发布一项Ⅰ期研究显示,对于恶性脑胶质瘤患者,TMZ可提高其中位生存期。TMZ于2008年进入我国,

病历摘要 患者男,62岁,因＂咳嗽3个月,腹痛、消瘦2个月＂于2010年10月29日入院。患者3个月前出现咳嗽,咳少量白痰,无发热、乏力、盗汗。2个月前无明显诱因出现腹胀、腹痛,腹痛无明显规律。1个月前因发热,体温39℃,在外院静点左氧氟沙星5 d后体温恢复正常。

Objective To explore the effect of radio frequency ablation (RFA) combined with transcatherterarterial chemo embolization (TACE) and percutaneous puncture hydrochloric acid injection(PHI) for hepatic tumors unable to resection. Methods The clinical data of 40 cases of patients with unable resection liver cancer (URLC) treated by RFA combined with TACE and PEI were analyzed retrospectively.Results There were 30 cases of primary hepatic tumor(PHT) and 10 cases of metastasis hepatic tumor(MPT) , in this series. Examination of ultrasound, CT and MRI showed the tumors shrink or steady in 39 patients.Among 30 patients with damage by ethanol, 18 cases were AFP positive before treatment and 16 cases of them AFP decreased to normal level after operation. No severe complication was seen in the series. Conclusion RFA combined with TACE and PEI is a safe, well tolerable and effective method for hepatic cancer, and may improve the treatment efficacy of URLC.

Objective To evaluate the application of a puncture guidance supporter in CT guided biopsy and interventional therapy.Methods Totally 468 patients underwent CT interventional biopsy(n=110) or treatment(n=358) using a puncture guidance supporter.The size of lesions was 2—15 cm.CT scanning was performed to determine the entry point,data of bi-directional needle angle α,θ and depth d before operation.After local anesthesia,the needle was punctured into skin through the puncture guidance supporter,the needle overlap CT positioning laser line in tilt angle(α) was adjusted and the puncture direction at angle θ.After CT scanning confirmed the needle aiming at target lesion,punctures were performed with the needle into the depth to hit the target.Results The total puncture hit rate was 100%,and one step hit rate was 96.79%.The average time from location scanning to hit the target was 8.4 min.The incidence of pneumothorax occurred in thorax management was 1.56%.Conclusion The application of puncture guidance supporter in CT interventional diagnosis and treatment makes operation more accurate,safe and convenient.

Surgical resection remains the cornerstone of therapy for early stage lung cancer. Five-year survival rates are reported as high as 92% for stage Ⅰ non-small cell lung cancer (NSCLC). However, many patients presenting with resectable early stage disease are unable to tolerate pulmonary resection, even sublobular resection, because of compromised cardiopulmonary functions or other comorbidities. Traditionally,patients deemed medically inoperable have been treated by external-beam radiation. But the results were poor with a mean survival of 20 months and a 5-years survival rate of 12%. In this scenario, we need to develop other non-surgical local therapies. One of these was image-guided percutaneous radiofrequency ablation(RFA).Many clinical trials show that RFA for lung tumors is a minimally invasive, feasible and safe technique with minor mortality and morbidity. Moreover, its efficacy seems to be promising, even in the long-term follow-up.Further experiences and comparison with other emerging minimally invasive local treatments are required to determine its rote in the treatment of medically inoperable early stage NSCLC.

目的:评价国产长春瑞滨(盖诺)与顺铂联合化疗对治疗老年人晚期非小细胞肺癌的近期疗效和毒性反应。方法:化疗方案采用长春瑞滨25mg/m2第1、8天静脉推注,顺铂20mg/m2第1～5天,至少治疗2个周期,评价疗效及毒性反应。结果:39例中CR0例,PR15例,SD18例,PD6例,ORR38.46%(15/39),临床症状改善明显。主要毒性反应为骨髓抑制、消化道反应。结论:该方案治疗老年人晚期非小细胞肺癌的疗效较好,毒性反应可耐受,提高了患者生活质量。

OBJECTIVE:To evaluate the efficacy of Interleukin II plus Cisplatin for patients with malignant pleural effusion.METHODS:Thoracentesis was performed in 52 patients with malignant pleural effusion,and single lumen central venous catheter(purchased from Arrow Company,US)was inserted in the patients for closed drainage of the pleural fluid.And the patients were randomized to two groups:32 cases(Group A)were injected(via thoracic cavity)with interleukin Ⅱ(2 000 000～3 000 000 units each time)plus cisplatin(80～100 mg each time)while 20 cases(Group B)were injected with cisplatin(80～100 mg each time)alone weekly for 3 consecutive weeks.RESULTS:The effective rate was 84.4% in Group A [8(25.0%)CR cases and 19(59.3%)PR cases] vs.65% in Group B [3(15.0%)CR cases and 10(50.0%)PR cases].After treatment,the KPS scores for all the patients were ranged from 60 to 90,up by an average of more than 10 scores as compared with before treatment,and all the PR or CR patients had improvement in characteristics of pleural fluid.CONCLUSION:Interleukin II plus Cisplatin is superior to cisplatin alone in the treatment of malignant pleural effusion.It improves patients' respiratory function and immunity.Furthermore,the injury arose from thoracentesis performed to insert catheter for drainage is mild and in which the complications such as multilocular pleural adhesion and encapsulation and pneumothorax are avoided and the method is simple and safe with mild side effects.

CT介入诊疗技术在计算机辅助X线断层影像的引导和监控下,借助于各种微创诊疗器械,经皮穿刺病变,进行检查、活检、治疗.CT引导下徒手穿刺技术、操作及其准确性受经验因素影响较大.激光引导和穿刺导向器辅助CT引导操作简便、命中准确、扫描层数少、并发症少.CT引导支架可以保持穿刺针"瞄准"病灶,穿刺命中靶点,此方法操作简便、扫描层数少、命中率高、并发症少.大大降低了CT介入的难度,易于推广应用.套管技术为活检针建立了一条通路,实现多点、多次取材,可以获得满意足量的标本,通过套管针注射止血药、抗癌药、医用胶,可以止血、防止针道种植,有效降低了穿刺风险.微米注射针通过套管针穿刺肿瘤内,损伤小、药物返流少,提高治疗效率,减少不良反应.CT引导下介入诊疗涉及到多个系统,CT引导穿刺的准确率为86%～96%,穿刺活检不会造成肿瘤播散种植,已成为临床医生获取一级诊断的重要手段之一.经皮肿瘤内注射将药物直接作用于肿瘤组织,达到治疗目的.经皮乙醇注射和经皮醋酸注射已成为肝癌局部治疗的公认方法之一,经皮盐酸注射利用胃液主成分盐酸具有杀灭癌细胞,凝固癌组织的特点,灭活癌组织的活性是无水乙醇的15倍,可以替代无水乙醇进行化学消融治疗.CT介入射频消融和微波消融治疗肝癌、肺癌,已成为肿瘤治愈性手段之一.经皮穿刺治疗肝肾囊肿,可以代替传统的手术治疗.随着CT、MRI与穿刺技术的发展,影像断层微创诊疗专业技术会给医学带来进步.

OBJECTIVE: To observe the clinical efficacy of Cluster Electrode Radiofrequency Ablation(RFA)in combination with Paclitaxal plus Carboplatin(PC)for advanced Non-small Cell Lung Cancer(NSCLC).METHODS: 30 patients with advanced NSCLC of stage Ⅲ and stage Ⅳ were treated with RFA and PC combination therapy,the results were compared with those underwent PC chemotherapy alone(n=28).RESULTS: The RFA and PC combination therapy group was superior to the PC group in therapeutic effect,the life quality scores and the survival time,and there was a statistical significance in the therapeutic effects between the two groups(P0.01).CONCLUSION: The RFA and PC combination therapy can improve the therapeutic efficacy in patients with advanced NSCLC and it can serve as a new comprehensive therapy in the treatment of advanced NSCLC.

目的:观察CT介导经皮肺穿刺射频原位灭活术在肺癌中应用的有效性和安全性。方法:在CT的导向和监控下,对50例不同病理类型的肺癌进行多极射频原位灭活治疗。观察影像学变化、肿瘤灭活率和生存。结果:治疗后CT示肿瘤密度降低、外形缩小,无强化,肿瘤高代谢灶消失呈无代谢信号,穿刺活检均为坏死组织,直径≤3cm肿瘤总灭活率为100%。肿瘤较大者需要2次以上的消融治疗,1年生存率80%,2年生存率50%。治疗中血压、脉搏和外周血氧饱和度无明显改变;治疗对肝肾功能、肺功能无明显影响。结论:CT介导经皮射频原位灭活治疗肺癌创伤小,效果好,是一种安全有效的微创治疗新方法。

Objective:To evaluate in situ destructive effects and safety of CT mediated percutaneous hydrochloric acid injection therapy for liver cancer.Methods:Guidance and monitored by CT slice simulation puncture technique,35 patients with 48 malignant lesions of primary liver cancer were treated intratumor injection of a protein destructive agent contained 6mol/L hydrochloric acid.The in situ destructive rate,imaging and histopathology evaluation,survival rate and side effects were observed.Results:A low density and no enhancement of tumor by CT scan were shown.A well necrosis and destructive rate of cancer was obtained by PET,biopsy and AFP measurement.The overall 1-,2-,and 3-year survival rates were 100%,91% and 64%,respectively.Three cases of all patients had survived over 4 years.The reason of death was recurrence and metastasis.No changes of hart,liver and kidney function were fund.Mean side effects were slight pain,lower fever and so on.Conclusion:CT mediated percutaneous hydrochloric acid injection therapy(PHAIT)shown well in situ destructive effects and was a new method for percutaneous treatment of the liver cancer.